Background: Suicides by any method, plus 'nonsuicide' fatalities from drug self-intoxication (estimated from selected forensically undetermined and 'accidental' deaths), together represent self-injury mortality (SIM)fatalities due to mental disorders or distress. SIM is especially important to examine given frequent undercounting of suicides amongst drug overdose deaths. We report suicide and SIM trends in the United States of America (US) during 1999À2018, portray interstate rate trends, and examine spatiotemporal (spacetime) diffusion or spread of the drug self-intoxication component of SIM, with attention to potential for differential suicide misclassification. Methods: For this state-based, cross-sectional, panel time series, we used de-identified manner and underlying cause-of-death data for the 50 states and District of Columbia (DC) from CDC's Wide-ranging Online Data for Epidemiologic Research. Procedures comprised joinpoint regression to describe national trends; Spearman's rank-order correlation coefficient to assess interstate SIM and suicide rate congruence; and spacetime hierarchical modelling of the 'nonsuicide' SIM component. Findings: The national annual average percentage change over the observation period in the SIM rate was 4.3% (95% CI: 3.3%, 5.4%; p<0.001) versus 1.8% (95% CI: 1.6%, 2.0%; p<0.001) for the suicide rate.
Purpose
Rural communities are among the most underserved and resource‐scarce populations in the United States. However, there are limited data on COVID‐19 outcomes in rural America. This study aims to compare hospitalization rates and inpatient mortality among SARS‐CoV‐2‐infected persons stratified by residential rurality.
Methods
This retrospective cohort study from the National COVID Cohort Collaborative (N3C) assesses 1,033,229 patients from 44 US hospital systems diagnosed with SARS‐CoV‐2 infection between January 2020 and June 2021. Primary outcomes were hospitalization and all‐cause inpatient mortality. Secondary outcomes were utilization of supplemental oxygen, invasive mechanical ventilation, vasopressor support, extracorporeal membrane oxygenation, and incidence of major adverse cardiovascular events or hospital readmission. The analytic approach estimates 90‐day survival in hospitalized patients and associations between rurality, hospitalization, and inpatient adverse events while controlling for major risk factors using Kaplan‐Meier survival estimates and mixed‐effects logistic regression.
Findings
Of 1,033,229 diagnosed COVID‐19 patients included, 186,882 required hospitalization. After adjusting for demographic differences and comorbidities, urban‐adjacent and nonurban‐adjacent rural dwellers with COVID‐19 were more likely to be hospitalized (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI], 1.16‐1.21 and aOR 1.29, CI 1.24‐1.1.34) and to die or be transferred to hospice (aOR 1.36, CI 1.29‐1.43 and 1.37, CI 1.26‐1.50), respectively. All secondary outcomes were more likely among rural patients.
Conclusions
Hospitalization, inpatient mortality, and other adverse outcomes are higher among rural persons with COVID‐19, even after adjusting for demographic differences and comorbidities. Further research is needed to understand the factors that drive health disparities in rural populations.
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